title: Military sexual trauma among homeless veterans.
abstract: BACKGROUND
  Military sexual trauma (MST) is the Veteran Health Administration's (VHA) term for sexual assault and/or sexual harassment that occurs during military service. The experience of MST is associated with a variety of mental health conditions. Preliminary research suggests that MST may be associated with homelessness among female Veterans, although to date MST has not been examined in a national study of both female and male homeless Veterans.
  
  
  OBJECTIVE
  To estimate the prevalence of MST, examine the association between MST and mental health conditions, and describe mental health utilization among homeless women and men.
  
  
  METHODS
  National, cross-sectional study of 126,598 homeless Veterans who used VHA outpatient care in fiscal year 2010.
  
  
  METHODS
  All variables were obtained from VHA administrative databases, including MST screening status, ICD-9-CM codes to determine mental health diagnoses, and VHA utilization.
  
  
  RESULTS
  Of homeless Veterans in VHA, 39.7 % of females and 3.3 % of males experienced MST. Homeless Veterans who experienced MST demonstrated a significantly higher likelihood of almost all mental health conditions examined as compared to other homeless women and men, including depression, posttraumatic stress disorder, other anxiety disorders, substance use disorders, bipolar disorders, personality disorders, suicide, and, among men only, schizophrenia and psychotic disorders. Nearly all homeless Veterans had at least one mental health visit and Veterans who experienced MST utilized significantly more mental health visits compared to Veterans who did not experience MST.
  
  
  CONCLUSIONS
  A substantial proportion of homeless Veterans using VHA services have experienced MST, and those who experienced MST had increased odds of mental health diagnoses. Homeless Veterans who had experienced MST had higher intensity of mental health care utilization and high rates of MST-related mental health care. This study highlights the importance of trauma-informed care among homeless Veterans and the success of VHA homeless programs in providing mental health care to homeless Veterans.
authors.affiliation: National Center for Posttraumatic Stress Disorder, VA Palo Alto Health Care System, 795 Willow Rd (PTSD-324), Menlo Park, CA 94025, USA. Joanne.pavao@va.gov
authors.forename: Joanne
authors.initials: J
authors.lastname: Pavao
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Turchik
authors.forename: Jenny K
authors.initials: JK
authors.lastname: Hyun
authors.forename: Julie
authors.initials: J
authors.lastname: Karpenko
authors.forename: Meghan
authors.initials: M
authors.lastname: Saweikis
authors.forename: Susan
authors.initials: S
authors.lastname: McCutcheon
authors.forename: Vincent
authors.initials: V
authors.lastname: Kane
authors.forename: Rachel
authors.initials: R
authors.lastname: Kimerling
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology*; D012742:Sex Offenses / Q000523:psychology*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000523:psychology*; D058014:Veterans Health